This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. Health disparities refer to the adverse health outcomes experienced by racial/ethnic minorities. The Zuni Pueblo, located in rural portion NM, is home to ~11,000 Zuni Indians. Low rates of emigration and immigration have led to a relatively endogamous population characterized by large extended families. This socio economically disadvantaged population faces a major public health challenge from growing health disparities. Changing lifestyles have led to decreased physical activity and increased caloric intake with high consumption of fast food, soda pop and alcohol. Thus, the Zuni are experiencing interrelated epidemics of obesity, diabetes, hypertension, kidney disease and intermediate phenotypes. Since these conditions are also risk factors for cardiovascular disease (CVD) it is likely that there is also an unidentified epidemic of CVD. Decreasing the impact of these epidemics is complicated by a unique combination of historical, economic and cultural barriers, which limit health care utilization thereby increasing health disparities. Reducing heath disparities between the Zuni and more affluent populations poses a major public health challenge. To meet this challenge we will utilize a chronic care model that takes into account Zuni demographics, family structure, culture and tradition, health care needs and utilization of the on site Indian Health Service (IHS) to develop and pilot the Zuni Health Initiative (ZHI). When the full scale ZHI is implemented, it will have the potential to significantly reduce health disparities. We have established an education and health care consortium consisting of the Zuni Tribal Council, The Zuni Pueblo, IHS, Dialysis Clinic Inc. (DCI) and the University of New Mexico (UNM) to establish the ZHI. This consortium, built upon the infrastructure created by the NIH funded Zuni Kidney Project (ZKP), will develop and pilot the ZHI within the NM-InBRE program.